<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label for="c-instrumenttype" class="control-label col-xs-12 col-sm-2">{:__('Instrumenttype')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-instrumenttype" data-rule="required" class="form-control" name="row[instrumenttype]" type="text" value="{$row.instrumenttype}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-instrumentsno" class="control-label col-xs-12 col-sm-2">{:__('Instrumentsno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-instrumentsno" data-rule="required" class="form-control" name="row[instrumentsno]" type="text" value="{$row.instrumentsno}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-apisn" class="control-label col-xs-12 col-sm-2">{:__('Apisn')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-apisn" data-rule="required" class="form-control" name="row[apisn]" type="text" value="{$row.apisn}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-requestheader" class="control-label col-xs-12 col-sm-2">{:__('Requestheader')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-requestheader" class="form-control " rows="5" name="row[requestheader]" cols="50">{$row.requestheader}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label for="c-requesturl" class="control-label col-xs-12 col-sm-2">{:__('Requesturl')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-requesturl" data-rule="required" class="form-control" name="row[requesturl]" type="text" value="{$row.requesturl}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-requestdata" class="control-label col-xs-12 col-sm-2">{:__('Requestdata')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-requestdata" data-rule="required" class="form-control " rows="5" name="row[requestdata]" cols="50">{$row.requestdata}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label for="c-responsecode" class="control-label col-xs-12 col-sm-2">{:__('Responsecode')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-responsecode" class="form-control selectpicker" name="row[responsecode]">
                {foreach name="responsecodeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.responsecode"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label for="c-responsedata" class="control-label col-xs-12 col-sm-2">{:__('Responsedata')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-responsedata" data-rule="required" class="form-control " rows="5" name="row[responsedata]" cols="50">{$row.responsedata}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label for="c-memo" class="control-label col-xs-12 col-sm-2">{:__('Memo')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-memo" data-rule="required" class="form-control " rows="5" name="row[memo]" cols="50">{$row.memo}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label for="c-ip" class="control-label col-xs-12 col-sm-2">{:__('Ip')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ip" data-rule="required" class="form-control" name="row[ip]" type="text" value="{$row.ip}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
